Irritable Bowel Syndrome: Strategies for Managing a Complex Condition

Irritable bowel syndrome
(IBS) doesn't easily fit into the traditional medical model. Researchers have not yet come up with a coherent scientific explanation, let alone a cause, for its debilitating symptoms. This means that there is no cure or even a comprehensive treatment. The best that doctors can offer is management of symptoms, one at a time. It is no wonder IBS is a prime target for alternative therapies.

A Common Diagnosis

Doctors diagnose IBS in women three times more often than in men. Gastroenterologists report that it is the number one diagnosis they make.

Fifteen percent of Americans report symptoms consistent with IBS. The main symptoms are abdominal pain, usually associated with bloating and gas, and a change in bowel movements (diarrhea,
constipation, or alternating bouts of each). Mucus may be present with diarrhea, but there is no blood or pus.

Because tests show no abnormalities, physicians usually diagnose IBS only after ruling out similar diseases. Doctors suspect IBS when a person experiences at least 12 weeks of abdominal pain in the past 12 months, with at least two of the following features:

Pain is relieved after a bowel movement

The onset of pain is associated with diarrhea or constipation

The onset of pain is associated with a change in the form of the stool (loose, watery, or pellet-like)

A Complex Syndrome

While its exact cause remains a mystery, IBS is almost certainly due to a combination of genetic, environmental, and emotional factors, including:

Disjointed muscular contractions of the intestines, possibly related to stress or certain foods

Lower pain threshold due to excessive sensitivity of the intestine to being stretched

Increased levels of chemicals that transmit nerve signals to and from the intestine

Excessive focus on minor bodily symptoms and the fear that they mean something serious

Many people who see their doctors for IBS are found to have a psychiatric diagnosis (depression
or
anxiety, for example). There is no evidence, however, that psychiatric illness is the cause of IBS. It is clear, though, that changing emotional states influence the course of IBS.

Complementary Approaches

Dietary restrictions

Since IBS primarily affects the GI tract, diet is a good place to start. Many people benefit from avoiding certain foods and ingredients, such as:

Caffeine

Alcohol

Fatty foods

Gas-producing vegetables

Products containing sorbitol (eg, sugarless gum)

For those who find a connection between their symptoms and what they eat, avoiding those foods can be effective.

A controversial theory is that IBS may be associated with food allergies. If this is true, eliminating allergenic foods—dairy, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes—could theoretically help. One approach is to remove all these foods from your diet for two weeks. Then reintroduce foods one at a time every three to four days, and carefully monitor symptoms.

Fiber

Fiber may improve the colon's function and reduce symptoms, especially in people who tend to be constipated. Scientific research suggests that 20-30 grams of fiber per day is optimal. Good sources of fiber include:

Whole grains, fruits, vegetables, and legumes (dried beans)

Raw bran (1 teaspoon at each meal)

Psyllium seeds (4–5 grams of powdered husk mixed in at least 150 milliliters (ml) of water 1–4 times daily)

Flaxseeds
(1 tablespoon of whole seeds with at least 150 ml of water 2 –3 times daily)

Guar gum, partially hydrolyzed (may not be more effective than other forms of fiber, but may be better tolerated)

Peppermint

Of the many herbs and supplements that have been recommended for IBS,
peppermint
oil (Mentha x piperita)
is one of the few backed by some scientific evidence. The recommended dose is one or two 0.2-ml capsules three times daily after meals. Be sure to take the enteric-coated form, so that the capsule will not be broken down in the stomach before it reaches the intestines. Do not use this herb if you have unresolved gallbladder disease.

Stress management

Stress management and exercise have the potential to significantly ease IBS symptoms. A connection between psychological stress and IBS is certainly plausible, but the nature of this association is complex and poorly understood. There is some evidence to suggest that various mind-body interventions can reduce symptoms and change the course of IBS. The most promising of these are:

These medications, while often helpful, are no substitute for a comprehensive lifestyle approach. By finding effective ways to manage stress, exercise regularly, and modify your diet you can attempt to address the complex underlying causes of IBS.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY.
Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

DISCLAIMER: This information is intended for educational purposes. EBSCO is in no way liable for the use of this information and makes no warranty or guarantee as to its accuracy.